Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 728T | GA |
NPI | 1003892019 |
---|---|
Provider Name | Dr. Michael R Barnett |
First Address | Lilburn, GA 30047 |
Second Address | Lilburn, GA 30047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 12/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202I418862 | PTAN (01) | GA |
410021154 | MEDICARE RAILROAD (01) | |
GRP1065 | GROUP PTAN (01) | GA |
U22188 | (02) |